DIAGNOSIS

MANAGEMENT
ABSES DM
RSUD ENDE
Juli 2022
 Diabetes
Mellitus

Diabetes mellitus (DM) is a clinical syndrome associated with

deficiency of insulin secretion or action.

DM has been associated with reduced response of T cells,

neutrophil function, and disorders of humoral immunity.
Consequently, DM increases the susceptibility to infections
Abbreviations: Rx (Treatment), Abx (Antibiotics), Asx (Asymptomatic), SSTI (Skin and soft tissue infections)
 Abscess

Cutaneous abscess is an infected nodule containing pus that

occur within the dermis and subcutaneous space. They occur
anywhere on the body; however, common locations for an
abscess to develop are the groin, buttocks, axillae, and
extremities. 
Etiology

01
community-acquired methicillin
resistant Staphylococcus aureus  (MRSA) – 44%
Enretococcus sp. – 9%
Gram negative ; Pseudomonas aeroginosa – 11%,
E. coli 7,2%
02
Foreign body response (splinter,
ruptured inclusion cyst, injection sites)
– sterile abscess
Patogenesis

Abscesses usually occur in folliculocentric infections, i.e. folliculitis, furuncles, and carbuncles
that develop into abscesses. Abscess can also occurs at the site of trauma, foreign body, burn, or
insertion site intravenous catheter.

Abscess occurs due to the body's defense reaction from tissues to prevent the spread of infection
in the body. Infectious agents cause inflammation and infection of cells in the environment,
causing the release of toxins.

The toxin causes inflammatory cells, white blood cells to go to the site of inflammation or
infection. An abscess wall is formed to prevent infection from spreading to the other body parts.
However, the encapsulation prevents immune cells from attack the causative agent of infection in
the abscess
Diagnosis In most cases, a cutaneous abscess can be diagnosed
clinically on the basis of physical examination alone. 

Sign & Symptoms :

Laboratory and Imaging Test :
- Tender red nodule forms
- In time (day-weeks) - Leukocytosis
- Pus collects within central space - Hypoechoic fluid pocket on ultrasound
- Fluctuance of the central portion of lesion - Isolation of S. aureus on culture confirm
- Warmth the diagnosis
- Can occur at sites of trauma, foreign bodies,
burns, or site of insertion of iv chateters.
- Fever
Differential Diagnosis

Sellulitis
Furunkel/Carbunkel
commonly involves the lower
limbs and in most cases is Develops arround hair follicle
unilateral. 
No Fluctuance
Management
incision and drainage
antibiotic therapy alone is not sufficient for
treatment
In cases of
antibiotic small fluid
collections,
Antibiotic usage after incision and drainage is only conservative
recommended if management
- the lesion is severe or associated with sellulitis with
- there are signs of systemic illness antibiotics, in
- There are comorbid factors or immune suppression addition to the
- The patient is very young or very old manual
- If the abscess is in abody location that is difficult to expression of
drain pus can be
- There is associated septic phlebitis considered.
- No response to inscision and drainage alone

Comorbid control
 Incision & Drainage It is the primary treatment for skin and
soft tissue abscesses

Indications
Most patients with an abscess
Equipment
Contraindications
cleansing agent
large and deep abscesses, a local injectable anesthetic agent
the presence of a pulsatile mass at the site of infection, 5 to 10 mL syringe with 25 to 40 gauge needle,
proximity to the vasculature and nervous structures, scalpel blade with a handle,
curved hemostat, normal saline solution with large
syringe/splash guard/bowl for irrigation,
Preparation packing material (iodoform or plain gauze),
Informed consent from the patient or the patient’s swabs for wound culture (if desired), scissors and tape
legal guardian must be obtained before the for dressing the wound.
procedure. Risks including bleeding, pain and
possible scar formation should be relayed.
The verification of tetanus immunization status is
also an important step in preparation.
Incision & Drainage

Technique

Holding the scalpel with a steady grip, an incision is made directly over the center of the
abscess until pus is expressed.
The incision should be made parallel to skin tension lines in order to prevent scar tissue
formation.
A curved hemostat can then be used for blunt dissection to further disrupt loculations within
the infected cavity.
Manual expression can be used to facilitate drainage as well.
After the abscess is drained, the wound should be copiously irrigated with sterile normal
saline solution.
The next step is to cover the site with sterile dressing and tape.
A follow-up visit is advised 2 to 3 days after the procedure for removal of the packing.
Wounds are then left to close by secondary intention.
Antibiotic

Topical
 topical mupirocin is only recommended in mild cases

Oral
 Patients with no signs of systemic toxicity and uncontrolled comorbidities can usually
be managed with oral antibiotics as outpatients.

a. Dicloxacillin 250–500 perday;

b. Clindamycin 3x300–450 mg ;
c. Doxycycline 2x100 mg ;
d. Minocycline 2x50–100 mg;
e. Trimethroprim-sulfamethoxazole (TMX-SMX) 2x160/800 mg peroral
Antibiotic

Intravena
comorbid, immunosuppression
rapidly progressive infection
concern for deep space infection,
high fevers and rigors, h
aemodynamic instability
suppurative wound requiring surgical drainage
lack of systemic or local response to oral antibiotics,
rising or unchanging C-reactive protein
positive blood cultures
inability to tolerate or absorb oral antibiotics.
 Conclusion

Bacterial skin infections have a variety of presentations from

localised, trivial infection to rapidly progressive infection with
systemic toxicity and considerable mortality. It is important to be
able to recognise and treat these infections in the community, and in
cases of severe infection to refer the patient promptly for specialist
care.
Thank you